Crohn disease: neurologic manifestations

Jasvinder Chawla MD MBA (Dr. Chawla of Loyola University Medical Center and Chief of Neurology at Hines VA Hospital has no relevant financial relationships to disclose.)
Zachary N London MD, editor. (Dr. London of the University of Michigan has no relevant financial relationships to disclose.)
Originally released February 5, 2007; last updated November 23, 2016; expires November 23, 2019

This article includes discussion of Crohn disease: neurologic manifestations, regional enteritis, and granulomatous colitis. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

Crohn disease is an inflammatory bowel disease that predominantly involves the terminal ileum and colon. However, a wide range of extraintestinal complications may also compose a portion of the clinical picture. Extraintestinal manifestations may precede the onset of gastrointestinal symptoms by several years. Neurologic disorders associated with inflammatory bowel disease are reported in 3% of patients, but they often represent an important cause of morbidity as well as a diagnostic challenge. Besides the disease itself, the increasing use of immunosuppressant and other therapies may also play a crucial role in the development of neurologic disorders of different types and pathogenesis. Virtually all components of the nervous system, both central and peripheral, may become involved. Vigilance in recognizing neurologic dysfunction in the setting of Crohn disease, with prompt institution of appropriate treatment, can be important in avoiding irreversible consequences.

Key points

 

• Crohn disease is one of the inflammatory diseases that predominantly involve the gastrointestinal system, especially the terminal ileum and colon.

 

• A wide range of extraintestinal complications may compose a portion of the clinical picture. Neurologic dysfunction is an infrequent but potentially devastating extraintestinal manifestation of Crohn disease. Virtually all components of the nervous system, both central and peripheral, may become involved.

 

• Vigilance in recognizing neurologic dysfunction in the setting of Crohn disease, with prompt institution of appropriate treatment, can be important in avoiding irreversible consequences.

Historical note and terminology

Crohn, Ginzburg, and Oppenheimer pooled their experiences and described a condition they termed “terminal ileitis” (Crohn et al 1932). Colonic involvement was later recognized, prompting a renaming of the process as “regional enteritis” or “granulomatous enterocolitis.” More recently, however, it has become customary to use the eponymous designation, “Crohn disease.”

Earlier descriptions of what probably was Crohn disease can be found. Ulcerative colitis and Crohn disease are the most widely recognized members of a group of conditions collectively labeled inflammatory bowel disease. Despite many similarities, the clinical features and pathological profiles of the 2 conditions also demonstrate decided differences (Table 1). Neurologic dysfunction has been described in both. However, the focus in this article will be specifically on Crohn disease and its neurologic complications.

Table 1. Gastrointestinal Features of Inflammatory Bowel Disease

Ulcerative colitis

 

• Exacerbations and remissions typical
• Urgent, bloody diarrhea
Nausea and anorexia
• Weight loss
• Abdominal pain usually not prominent

Crohn disease

 

• Exacerbations and remissions typical
• Non-bloody, less urgent diarrhea
• Weight loss
• Abdominal pain prominent
• Anal and perianal lesions and fistulas
• Intestinal stricture formation

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